Just how accurate are the major risk stratification systems for early-stage endometrial cancer?

S Bendifallah¹, G Canlorbe², P Collinet³, E Arsène³, F Huguet⁴, C Coutant⁵, D Hudry⁵, O Graesslin⁶, E Raimond⁶, C Touboul⁷, E Daraï⁸, M Ballester⁸

Affiliations

¹ 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris 6, France.
² Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
³ Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
⁴ Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
⁵ Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
⁶ Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
⁷ Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
⁸ 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.

PMID: 25675149
PMCID: PMC4453957
DOI: 10.1038/bjc.2015.35

Comparative Study

Just how accurate are the major risk stratification systems for early-stage endometrial cancer?

S Bendifallah et al. Br J Cancer. 2015.

. 2015 Mar 3;112(5):793-801.

doi: 10.1038/bjc.2015.35. Epub 2015 Feb 12.

Authors

S Bendifallah¹, G Canlorbe², P Collinet³, E Arsène³, F Huguet⁴, C Coutant⁵, D Hudry⁵, O Graesslin⁶, E Raimond⁶, C Touboul⁷, E Daraï⁸, M Ballester⁸

Affiliations

¹ 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris 6, France.
² Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
³ Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
⁴ Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
⁵ Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
⁶ Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
⁷ Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
⁸ 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.

PMID: 25675149
PMCID: PMC4453957
DOI: 10.1038/bjc.2015.35

Abstract

Background: To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC).

Methods: Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination.

Results: Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70-0.76) and an area under the curve (AUC) of 0.80 (0.78-0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66-0.70), 0.65 (0.63-0.67), 0.66 (0.63-0.69), 0.71 (0.68-0.74), respectively, for RFS and an AUC of 0.69 (0.66-0.72), 0.69 (0.67-0.71), 0.68 (0.66-0.70), 0.70 (0.68-0.72), respectively, for node metastases.

Conclusions: None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.

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Figures

**Figure 1**
Discrimination of each RSS for recurrence and nodal metastases.

**Figure 2**
Recurrence-free survival curves according to each risk classification.

See this image and copyright information in PMC

References

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1. ASTEC study group. Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–136. - PMC - PubMed
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1. Ballester M, Canlorbe G, Cortez A, Gonin J, Laas E, Bendifallah S, Graesslin O, Daraï E. Histological and immunohistochemical profiles predict lymph node status in women with low-intermediate risk endometrial cancer. Gynecol Oncol. 2013;130:457–462. - PubMed

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Just how accurate are the major risk stratification systems for early-stage endometrial cancer?

Affiliations

Just how accurate are the major risk stratification systems for early-stage endometrial cancer?

Authors

Affiliations

Abstract

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References

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MeSH terms

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Full Text Sources

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Medical